Angioplasty and Percutaneous Coronary Stenting
"The patients are happier going home the same day. The procedure is just as safe as an overnight stay," says Michael Kim, MD, Assistant Professor of Cardiology and Director of the Coronary Care Unit. "Less than 5 percent of the interventional heart centers in the United States are sending patients home the same day," says Dr. Kim. "Mount Sinai Heart is the leader in the entire country in this."
When coronary arteries become narrowed or blocked, oxygen-rich blood can’t reach the heart muscle. This can cause angina (pain) or a heart attack. Angioplasty and percutaneous coronary interventions (PCI), a minimally invasive procedure, can keep blood flowing to the heart by widening or holding arteries open. At Mount Sinai Heart, this is a same-day procedure for most patients.
To perform a PCI, our interventional cardiologists thread a catheter fitted with a device (such as a stent or balloon) from a small incision in the groin or arm to the problem site in the heart. At the problem site, the device opens the blockage and restores adequate blood flow.
When possible, at Mount Sinai, we employ the transradial approach, which uses the arm as the access site, as opposed to the groin. By using the arm, we decrease post-procedure bleeding, urination challenges, and other issues. Since there are fewer complications, you are more likely to be discharged the same day.
Once we have opened up the blocked artery, we may use a stent to keep the artery open. Stents are small, wire mesh tubes that provide support inside blocked or narrowed coronary arteries, and hold them open. Over several weeks, the artery heals around the stents, keeping them in place and the artery open.
Sometimes we use drug-eluting stents (DES), which are coated with a slow-release medication that helps inhibit scar tissue growth around the stent. This reduces the chances that the blockage will re-form (called restenosis). According to the U.S. Food and Drug Administration, DES does not increase the risk of clotting (called thrombosis) any more than use of a bare metal stent (BMS). In fact, advances in polymer stent construction and the drug elution that coats the stent makes DES more effective than BMS.
Data show that 80 percent of patients who receive stents have low recurrence of arteries closing up again, and less than 10 percent require repeat interventions. With use of drug-eluting stents, the risk of scar tissue forming in the stented area is less than 10 percent. Many of our patients receive stents in multiple vessels.
If restenosis occurs, Mount Sinai Heart physicians can treat it with intravascular brachytherapy. In this procedure, we thread a catheter to the site where it remains for a few minutes while we administer a dose of radiation that will decrease additional episodes of restenosis.